STEPS HS PE PROGRAM ENROLLMENT Form

S.T.E.P.S HS PE PROGRAM ENROLLMENT FORM
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Place of Birth
Gender

MaleFemale
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level
School Year
School Last Attended
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
Parent/Guardian's Name - Secondary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.
Health History
If the student have any allergies, please list them down below:
Does the student currently taking any medications? If yes, please list them down below:
Was the student previously hospitalized or undergo any surgery?
Does the student have any medical conditions that you would like to declare?
Reminders
PFT TEST. The school requires all students to take a physical fitness test in order to get admitted to the school.

REQUIREMENTS. It is important to pass and complete all requirements before school starts. Failure to do so may delay the student from coming to school.

MEDICAL CLEARANCE. The school requires all students to have a yearly physical exam. For new students, medical clearance for their doctor is required.

BEHAVIOR. A certificate of good moral is required in order to get admitted to this school. Please request it from the previous school as soon as possible.

PAYMENT. Monthly payments are due at the beginning of every month. Each must pay nonrefundable enrollment fee of $100. $1st payment due on August 18th is $280. Each subsequent month will be $150.

*payments can be made via*
- zelle: raiseyourgamebasketball@gmail.com
- paypal: raiseyourgamebasketball@gmail.com
- venmo: @rygbball (include 3% sales tax)
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

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S.T.E.P.S HS PE PROGRAM ENROLLMENT FORM

Parent/Guardian's Information

Health History

Reminders